Journal / Testosterone for Women

Testosterone In Women: Everything You Need To Know

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Testosterone In Women: Everything You Need To Know

Do Women Need Testosterone? 

Testosterone in women is a necessary hormone. Testosterone (T) therapy is NOT for men only. We see lots of low testosterone (T) treatments, or “Low T treatment,” clinics – but they are all for men. Female testosterone replacement therapy (TRT) is available and can get you back to your appropriate testosterone levels quickly. 

It may seem like an unlikely treatment for menopause, but TRT in females is used safely and effectively. Women often ask, “What does testosterone do?”  Well, TRT can be a beacon of hope for many women who feel blindsided when they step into menopause. There is clear evidence of what testosterone, a natural remedy for aging and menopause symptoms, can do.1-4

Testosterone has many important functions in female physiology. When T levels drop, low testosterone women can suffer. This article will serve to explain what low testosterone treatments are available for you. 

As we age into our 30’s, the natural hormonal decline is gradual but relentless. Because it is typically a slow decline, women can be wooed into complacency about feeling – terrible. Unfortunately, women and even their healthcare providers often don’t recognize that their exhaustion, aching bones, weight gain (~ over 20 lbs), brain fog, and painful sex are caused by low estrogen, progesterone, and testosterone. TRT can help relieve these testosterone-related symptoms quickly and safely.

Knowing Testosterone

Yes, testosterone is the primary sex hormone in men, and it is responsible for the development of many of their physical characteristics that are considered male. We women also produce testosterone hormone, but in much smaller amounts. Both men and women experience significant drops in testosterone in their 30s.1

Men vs. Women: Testosterone is made in a man’s testicles and adrenal glands, and a woman’s ovaries and adrenal glands. In men, testosterone is what turns them from boys to men and plays a critical role in puberty. In both, T can send that spark of sexual desire. Specifically, a boy going through puberty may notice his penis and testicles grow, facial, pubic, and body hair develop, the voice deepens, muscles and bones become stronger, and his height increases. Women’s changes at puberty are mostly due to estrogen and progesterone.

Low Testosterone in Women & Men

Symptoms of lowered testosterone are frequently attributed with just getting older and while that’s true, the symptoms will become persistent and will only get worse. Decreasing testosterone levels don’t go back up unless we intervene.

Testosterone levels peak in a woman’s ’20s and by the time she is 50, her testosterone levels have likely decreased by about 50%.2,3,4,5 Testosterone drops in your 20’s and instead of leveling off, it only accelerates its downward momentum every year. When testosterone levels fall, in both men and women, it can lead to a number of distressing symptoms such as:1,3,11

  • Low sexual desire, arousal, orgasm

  • Reduction in general quality of life 

  • Tiredness & Fatigue

  • Mood Changes & Depression 

  • Headaches 

  • Hair thinning

  • Skin dryer and thin

  • Weight Gain

  • Cognitive problems 

  • Loss of muscle mass

  • Osteoporosis

  • Vaginal dryness (women only)

Menopausal symptoms such as hot flashes and night sweats can dramatically reduce a woman’s quality of life. Hormone replacement therapy (HRT) is used to ease these symptoms. Research has shown that giving TRT can ease menopausal symptoms, including hot flashes, sleep problems, irritability, and fatigue.3,4

Testosterone replacement therapy  is currently only FDA-approved for men who have been diagnosed with hypogonadism. but it’s also prescribed off-label for older men who take it in hopes that it will improve their libido. There is no FDA approval for women’s use of TRT even though the use of testosterone replacement therapy (TRT) is increasingly common. Testosterone for men is available in different forms, including topicals such as gels, creams, and patches; injections; and pellets.1

Historically, women have not been included in the conversation about testosterone replacement benefits. You’ve probably seen those ads targeted to men with “low T,” a drop in testosterone level that occurs with age. Women’s bodies also suffer from the drop in T, and yet you won’t see the same “low T” sales pitches directed to women, in part because no T product is FDA-approved for women.

Still, women deserve the right to choose to replace testosterone, not only to enhance their sex drive, but also to improve their muscle strength, bone density, or mood.3,4 Some women will try to use products licensed for men, but we DO NOT recommend using other persons’ prescriptions. There is a better way to replace your dropping testosterone. Taking DHEA is a preferable method to add T overusing products designed for men. Taking a man’s prescription is not legal and could lead to taking too much testosterone.

DHEA or Dehydroepiandrosterone (also known as androstenolone) is a chemical that can be broken down in your body to become testosterone. DHEA, a steroid precursor (also called prohormone), is a natural substance that your body can convert into testosterone and is one of the most abundant circulating steroids in humans.

DHEA is naturally produced in your adrenal glands, ovaries, and brain.5 By providing DHEA to women who are low in testosterone (T), they can increase their T levels by adding DHEA which converts to T.  We use DHEA, sometimes in combination with anastrozole, to gently and safely return testosterone to normal levels. DHEA is a testosterone precursor that the body naturally breaks down into a combination of estrogen and testosterone.

Anastrozole is a medication that can block the conversion of DHEA to estrogen. By adding anastrozole, more of the DHEA ends up as testosterone. This can give a slightly higher testosterone boost for women that need a bit more testosterone.

Supplements and Lifestyle Are Other Ways to Increase T Levels:14

  1. Exercise Regularly, and Lift Weights. Exercise raises T levels, specifically weight training.

  2. Eat More Beans, Protein and Nuts that can stimulate T production (eggs, lentils, almonds, coffee).

  3. Get Some Sun and/or Take a Vitamin D Supplement.

  4. Take Vitamin and Mineral Supplements. 

  5. Taking amino acid supplements may help raise T levels, but evidence in women is lacking.

  6. Keeping a Healthy Weight is always a good idea.

  7. Sleep 7-8 Hours Every Night. Sleep deprivation affects all hormones including testosterone.

  8. Have Sex. Some research indicates that having sex helps raise your testosterone levels. 

  9. Manage Stress Hormone Cortisol Levels. High cortisol can block T production.

  10. Reduce Alcohol Consumption. Alcohol decreases the rate that testosterone is made.

  11. If you are still taking birth control pills, they may be altering T levels.

  12. Antidepressants can decrease T levels. 11

  13. Vegetarian diets can also decrease T levels. 

Testosterone for Women to Gain Weight or Lose weight

Proper testosterone levels can help women with weight loss and avoid the deposition of fat in the belly and back.11 Even though women produce about one-tenth the amount of testosterone than men do, testosterone is the hormone responsible for increased muscle mass, bone density, and body hair. Low testosterone levels in either men or women, can have negative effects on health such as obesity.11

When testosterone levels decrease, both men and women can gain weight. Women gain weight easier than men.  As women grow older, the sex hormones estrogen and progesterone begin to fluctuate, at the same time as testosterone.  With these fluctuations, estrogen, progesterone, and testosterone balances get thrown off. Weight gain can result.

Testosterone is responsible for increased muscle mass and with a leaner body mass, you can better control your weight and increase your energy levels. Research studies show that T treatment can decrease overall body fat and increase muscle tone and strength. 

By increasing your muscle mass, you are increasing your metabolism. Weight loss occurs when the amount of calories consumed is less than the amount of calories burned. As T drops with age, we require fewer calories. Returning testosterone to normal levels can reverse this trend.

If your T is low, you can exercise the same amount (or more) and will see less improvement in lean muscle mass than a woman with normal testosterone. When you improve your body’s response to exercise by increasing T, you will likely notice the benefits.

Replacing low testosterone to normal levels can also improve energy and decrease fatigue.6,7 Women with low testosterone are more prone to experience low energy and fatigue. Returning testosterone to normal levels will help to increase overall energy levels and can help you feel better. Think about how much energy you had when you were in your 20s. 

One of the unfortunate parts of aging is the loss of energy and the body’s ability to refresh itself. One of the reasons we lose so much energy as we age is because of falling testosterone levels. Testosterone stimulates red blood cell production and can stabilize your iron levels.11 Red blood cells and iron work together to carry oxygen to your cells. When you aren’t able to carry enough oxygen you can start feeling easily fatigued. Returning testosterone to normal levels will increase the body’s ability to refresh and increase overall energy levels.4,6

Returning normal energy levels via testosterone replacement can have a profound impact on your quality of life. Decreasing fatigue can improve mood, boost confidence, and allow for activities that increase happiness.

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Testosterone’s Important Roles 

Let’s take a look at some of the other significant roles testosterone plays in women:

Sex & Vaginal Health 

The percentage of women experiencing sexual dysfunction between the ages of 18 and 59 is about 50%, which is likely a result of low testosterone. A sign of low testosterone levels in females is HSDD (hypoactive sexual desire disorder). HSDD has defined as little or no sexual thoughts or fantasies and little or no desire for sexual activity to the point that a person experiences distress.11

Testosterone regulates the desire to have sex. Testosterone levels in women help drive lIbido, sexual response, orgasm, and overall sexual satisfaction.5,6 While decreased sex drive or libido can happen due to lots of reasons when you are a woman over the age of 40, it is the low testosterone levels that have been found to be a major risk factor in low libido.5,6 Studies have shown that by replacing T to normal youthful levels you can return your normal sexual desire.

Beyond just desiring sex more, low testosterone levels can reduce the size and sensitivity of your clitoris which can make it more difficult to reach orgasm or even lead to loss of orgasm potential. Replacing testosterone to normal levels can reverse these changes. Testosterone helps with the resilience of the vaginal and the natural lubrication which can further improve the experience and decrease associated pain. Women who replace testosterone levels report increased overall sexual satisfaction and increased quality of life. 

Brain Health

Normal testosterone levels in women are key to brain health. Clarity of thought, improved concentration, and overall cognition come with normal T levels. When T levels drop brain fog can be the result. Low T levels in women are also associated with significant mood changes including anxiety, depression, and irritability. Replacing testosterone and returning levels to youthful numbers can reverse these symptoms and return women to a state of good mental health.5

Bone health

Loss of bone mineral density is associated with increased bone-breaking and fracture risk and is an important health concern for women as they age. Osteoporosis is responsible for loss of height, fractures of the vertebrae, back pain, abnormal curvature of the spine, and even nerve damage.1,5

Low testosterone levels in women have been found to be an important risk factor for bone mineral density loss in women. Replacing testosterone to normal levels in women can be an important part of maintaining bone mineral density.

Urinary Health

Low T has been shown to increase both stresses and urge incontinence in women. Stress incontinence is when urine leaks out when your bladder is under pressure; like when you cough or laugh. Urge incontinence occurs when urine leaks as you feel a sudden urge to pee. As the pelvic muscles weaken with low T, incontinence increases.12

Breast Protective

Replacing T, back to normal levels, has a beneficial effect on breast tissue. T can help protect the breast from cancers. You can further enhance the protection testosterone provides by giving an additional ingredient with the DHEA, an aromatase inhibitor, such as Anastrozole. These protective effects on the breast are even more pronounced than with testosterone alone.

Quality of Life and Feelings of Wellbeing

Women feel better when they get their T levels back to normal youthful levels. Why? Sexual health improves, lean muscle mass returns, weight loss becomes easier, and energy levels increase. All these positive changes lead to improved feelings of well-being and enhanced quality of life. Women tend to feel more confident and relationships improve.9

Anti-Aging

Replacing testosterone to your normal youthful levels has an anti-aging component for skin, hair, and nails.

Here is a full list of the roles testosterone can play in a woman’s health:

  • Energy & Metabolism

  • Urogenital Health

  • Mood and Quality of Life

  • Brain Health & Cognitive function

  • Muscle health and strength

  • Bone health and strength

  • Breast health

  • Sexual arousal, libido & orgasm

  • Vaginal health, decrease vaginal atrophy

  • Fat distribution & reduction

  • Red blood cell production

  • Anti-Aging

  • May help cardiovascular health14,15,16

High Testosterone in Women 

Clinical trials have demonstrated that as long as appropriate levels of testosterone are maintained and levels don’t exceed the normal physiological dose, adverse androgenic effects are not problematic. Possible side effects include:

  • Increased body hair at the site of the application is occasionally a problem if the cream is applied to the same location and too thick (uncommon)

  • Alopecia, male pattern hair loss (uncommon)

  • Acne and greasy skin (uncommon)

  • Deepening of voice (rare)

  • Enlarged clitoris (rare)

Myths associated with testosterone replacement in women:

  • Testosterone replacement will make me look like a man. This is false. Replacing testosterone to normal levels has very few, negative side effects. Some women may experience mild acne or hair growth but most have no detrimental side effects.

  • Testosterone replacement will give me huge muscles. Another falsehood. Women who take huge doses of testosterone and train to increase muscle mass can transform their bodies into the stereotypical 1970’s athletes. This will not occur in normal replacement doses.

  • Testosterone replacement will change my personality and make me aggressive. Also not true. Replacing testosterone to normal levels will not adversely impact a woman’s moos. Rather, it can help improve mood by helping you to feel better and improve the quality of life.

  • Testosterone replacement is dangerous for my liver. Another false myth. Testosterone is indeed metabolized by the liver. Women who have pre-existing liver disease should not take hormone replacement. In healthy women, replacing testosterone with normal levels will not hurt the liver.

Who shouldn’t use testosterone?

  • During pregnancy or breastfeeding

  • Active liver disease

  • History of hormone-sensitive breast cancer 

  • Women with upper normal or high baseline testosterone levels

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Summary

TRT is an important part of hormone replacement therapy (HRT). You can use natural remedies for low testosterone like DHEA which can serve as a low testosterone cure. Women on T replacement therapy can improve their libido, have more energy, and have a sense of improved wellbeing. 

Winona offers testosterone medication for symptoms of low testosterone in women in a natural way. It works by replacing falling T to normal levels without risking going too far and ending up with high testosterone levels. 

When considering hormone replacement in women, TRT benefits should not be discounted. Ask your Winona physician about how adding testosterone to hormone replacement therapy can be a safe and important part of helping women feel young.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”

References:

  1. https://www.everydayhealth.com/testosterone/guide/

  2. Glaser, Rebecca, and Dimitrakakis, Constantine, “Testosterone Therapy in Women: Myths and Misconceptions.” Maturitas, Vol 74, issue 3, 2013, 230-234

  3. https://www.oprah.com/health/testosterone-replacement-therapy-for-menopause

  4. https://www.healthline.com/health/womens-health/do-women-have-testosterone

  5. https://thebms.org.uk/publications/tools-for-clinicians/testosterone-replacement-in-menopause/

  6. https://www.mayoclinic.org/diseases-conditions/menopause/expert-answers/testosterone-therapy/faq-20057935

  7. Watson RR (22 July 2011). DHEA in Human Health and Aging. CRC Press. pp. 208–.ISBN  978-1-4398-3884-6

  8. https://www.monash.edu/medicine/sphpm/units/womenshealth/info-4-health-practitioners/therapeutic-use-of-testosterone-for-women

  9. https://www.biotemedical.com/research/testosterone-insufficiency-and-treatment-in-women-international-expert-consensus-resolutions/

  10. MF. Sowers, et. al., “Testosterone Concentrations in Women Aged 25 – 50 Years: Associations with Lifestyle, Body Composition, and Ovarian Status,” American Journal of Epidemiology, Vol 153, Issue 3, 2001, 256-264

  11. S Bolour and G Braunstein, “Testosterone Therapy in Women: a Review,” International Journal of Impotence Research, 17, 2005, 399-408

  12. https://journals.physiology.org/doi/full/10.1152/ajpendo.00184.2014

  13. https://pubmed.ncbi.nlm.nih.gov/28847480/

  14. https://theantiagingclinics.com/helps-increase-testosterone-production/

  15. https://www.everlywell.com/blog/testosterone/unhealthy-testosterone-levels-in-women-some-causes-and-symptoms/